Noninvasive Cardiac Testing No Better Than Clinical Eval for Low-Risk Acute Chest Pain

By Kelly Young

Edited by David G. Fairchild, MD, MPH, and Lorenzo Di Francesco, MD, FACP, FHM

Noninvasive testing for acute chest pain in the emergency department is associated with longer hospital stays — but no better clinical outcomes — according to a retrospective study published in JAMA Internal Medicine and presented at the American Heart Association conference.

In this secondary analysis of a randomized trial, researchers studied 1000 patients with chest pain suggesting acute coronary syndrome, plus negative biomarkers. The 88% who received any noninvasive testing (e.g., coronary CT angiography, treadmill test, stress echocardiography) were compared with patients who didn't receive testing beyond electrocardiogram and biomarker testing.

After adjustment, patients who received only clinical evaluation had a shorter hospital stay than the noninvasive testing group (20 vs. 28 hours). Secondary outcomes like direct ED discharge, hospital admission rate, and 28-day rate of major cardiovascular events didn't differ between groups. The clinical evaluation group had lower ED costs (median, $1470 vs. $1940) and less radiation exposure.

One of journal's editors notes that "clinicians may wish to consider following patients with low-risk chest pain and reserving noninvasive testing if indicated by subsequent events."